Abstract

A 29-year-old male presented with progressive spastic quadriparesis over two years, predominantly affecting the lower limbs, with in associated stiffness, gait disturbances, and urinary urgency. Neurological examination revealed symmetric spastic quadriparesis, hyperreflexia, and a positive Babinski sign, but no sensory or cognitive deficits. MRI brain imaging displayed the distinctive “wine glass” sign, indicating symmetric hyperintensities in the corticospinal tracts, suggestive of bilateral corticospinal tract involvement. This radiological feature is associated with hereditary spastic paraplegia (HSP), particularly autosomal recessive spastic paraplegia type 7 (SPG7). The patient was managed with physical therapy and antispasticity medications. The “wine glass” sign is a significant radiological marker in diagnosing neurodegenerative conditions like HSP, primary lateral sclerosis (PLS), and leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL). This case underscores the importance of this MRI finding in guiding the diagnosis and management of spastic quadriparesis in young patients.